Primary Care Networks (PCNs) have been used for many years to provide clinical oversight of patient care and to help control the cost of care and enhance the quality of care. Multiple implementation approaches [...]

As more and more health systems consider population based reimbursement, pursue the development of ACOs, and consider value based reimbursement methods, they are faced with the age-old question of “how do we distribute the [...]

I once saw a billboard advertising a new insurance product co-branded by the local hospital system and a large national insurance carrier. The promise was 8-15% in premium savings. That makes sense, I thought, [...]

Under the Affordable Care Act (i.e., ACA), groups with 50 or less employees will eventually be subject to the ACA’s modified community rating rules. While some groups will see lower premiums than they would [...]

Defining a “Successful Rate Filing” For purposes of this writing, a successful rate filing: a) Is accepted by the rate reviewers and regulators without changes and with no, or very little, questions or [...]